When Percy turned 20, he decided to show the other young men in his South African village that he was a real man.

“They kept saying I looked like a girl - too weak to go to the bush,” said the young man from the south-eastern village of Flagstaff who did not want to give his surname.

“I decided to prove them wrong.”

Percy went into the wilderness where circumcision ceremonies are traditionally performed in June 2013.

He said he was “very happy and excited,” accompanied by 23 other initiates, a 28-year-old circumciser and his helpers.

But the Mpondo ethnic group that Percy belongs to - a subgroup of the Xhosa, which numbers more than 7 million people - had stopped circumcising in the mid-19th century, because chief Faku decided men recovering from the procedure were too weak to go to war.

When the practice was reintroduced with the encouragement of a Xhosa nationalist movement in the early 20th century, older men who had traditionally supervised the procedure were no longer circumcised, and much of the ancient medical knowledge had been lost.

Circumcision ceremonies fell into the hands of young and inexperienced men or quack doctors.

Now, a debate is raging about whether to allow them to continue operating or whether to switch to modern medical methods.

In Percy's case, the circumcision went badly wrong.

“We were all circumcised in the same hut. I did not cry. Those who cried were called weaklings and beaten up.”

A leaf was then placed on Percy's penis and tied up with a string, he said.

“If you complained about the pain, the string was tightened even more.”

The initiates were painted white, a colour meant to ward off evil, and left in the hut for a week.

They were not allowed to drink to prevent them from urinating, which could affect the cut. They were only given maize to eat.

By the fifth day, Percy was in intolerable pain and too weak to walk. He was driven to a hospital and underwent surgery.

He will bear a scar for the rest of his life.

When the young man returned home, he did not tell his fellow villagers what had happened.

“You are not supposed to discuss details of your circumcision,” he said.

“I could have been beaten up.”

A goat was slaughtered for the ancestors to mark his circumcision.

This year, Percy's 16-year-old cousin decided that is was time for him to enter adulthood.

While his cousin planned his circumcision, Percy did not dare talk about his own experience.

The cousin, whose name was withheld, died of complications after the ceremony this month. Percy and his cousin are not alone. About 900 boys have died of similar complications since 1995 in the south-eastern province of Eastern Cape, where the ritual is most widely practiced in South Africa, said Dr Dingeman Rijken, who works in the area and launched an awareness campaign.

Unsterilised blades, bleeding, ragged wounds and insufficient or excessive removal of the foreskin are among the leading causes of complications.

The manhood rite of male circumcision in Sub-Saharan Africa, which is unrelated to being Muslim or Jewish, is meant to teach boys self-control, integrity and a sense of responsibility.

Tens of thousands of South African males aged 16 to nearly 30 are circumcised annually in ceremonies that can last for months. The number of circumcised men is not known.

“When it is done properly in the traditional way, it becomes the outward sign of a massive inner transformation,” said Catherine Burns, a historian who has studied circumcision at Johannesburg's Witwatersrand University.

There is little academic knowledge about how common circumcision-related medical problems are in other African countries, Burns said.

But there is undoubtedly a high level of complications in South Africa, where the 1948-94 apartheid regime undermined the authority of traditional chiefs supervising the ceremonies.

The foreskin is a common breeding ground for infections, and the government of a country with one of Africa's highest HIV infection rates is campaigning in favour of circumcision, but officials want the procedure to be done in a modern medical manner.

The government has set aside 20 million rand for traditional chiefs to identify medical doctors to perform the ritual, said Joe Maila, a spokesman for the Department of Health.

Many traditionalists reject painless circumcision and the presence of female nurses at circumcision sites.

“We are looking into how to synergise traditional and modern medicine,” said Kjofi Pilane, vice-president of the Congress of Traditional Leaders of South Africa.

That merging is already being done among South Africa's 11 million Zulus, whose King Goodwill Zwelithini reintroduced circumcision to fight Aids two centuries after King Shaka abolished it to keep men fit for battle.

More than 70 000 Zulu men have been circumcised since 2010 in a procedure combining modern medicine with prayers to the ancestors.

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